Cartilage Repair System WIth Flexible Trephine

ABSTRACT

A system for repairing cartilage includes a trephine having a passage extending along a longitudinal axis of the trephine. The trephine has a distal end and a proximal end. The distal end includes a cutting member operable to cut a cartilage plug from a donor site. The passage is operable to receive the cartilage plug. Also, the trephine is flexible to selectively move between a first position in which the longitudinal axis is substantially linear and a second position in which the longitudinal axis is nonlinear. Moreover, the system includes a guide tool that is removably coupled to the trephine. The guide tool is operable to selectively move the trephine between the first and second positions. In addition, the system includes an ejector tool that ejects the cartilage plug from the passage toward a defect site.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a divisional of U.S. application Ser. No. 12/862,378filed on Aug. 24, 2010. The entire disclosure of the above applicationis incorporated herein by reference.

FIELD

The following relates to cartilage repair systems and methods and, morespecifically, relates to a cartilage repair system with a flexibletrephine and methods of use thereof.

BACKGROUND

The statements in this section merely provide background informationrelated to the present disclosure and may not constitute prior art.

Various systems and procedures have been proposed for repairing damagedcartilage within a patient's body. For instance, healthy cartilage canbe harvested from one area of the body (i.e., the donor site) and movedto another area of the body (i.e., the defect site) where cartilage isdamaged. The harvested cartilage can be attached to the defect site, andthe harvested cartilage can then grow on and repair the defect site.

In some cases, access to the donor and/or defect site can be limited.For instance, anatomical features may get in the way of certaininstruments, thus limiting the ability of the surgeon to obtaincartilage from the donor site and/or place the harvested cartilage onthe defect site. Also, the harvesting instruments may have limitedaccess to the donor and/or defect site because these sites may havecomplex surface curvature. This limited access can complicate theharvesting procedure, for instance, necessitating multiple incisions inthe patient, etc.

Thus, a system for repairing damaged cartilage is discussed in detailherein below. A method of using this system to repair damaged cartilageis also disclosed.

SUMMARY

A system for repairing cartilage is disclosed that includes a trephinehaving a passage extending along a longitudinal axis of the trephine.The trephine has a distal end and a proximal end. The distal endincludes a cutting member operable to cut a cartilage plug from a donorsite. The passage is operable to receive the cartilage plug. Also, thetrephine is flexible to selectively move between a first position inwhich the longitudinal axis is substantially linear and a secondposition in which the longitudinal axis is nonlinear. Moreover, thesystem includes a guide tool that is removably coupled to the trephine.The guide tool is operable to selectively move the trephine between thefirst and second positions. In addition, the system includes an ejectortool that ejects the cartilage plug from the passage toward a defectsite.

A method of repairing cartilage in a patient is also disclosed. Themethod includes operably coupling a guide tool to a trephine. Thetrephine has a longitudinal axis with a variable curvature. The methodfurther includes guiding the trephine with the guide tool to adjust thecurvature of the longitudinal axis of the trephine between a firstcurvature and a second curvature. Moreover, the method includes removinga cartilage plug from a donor site in the patient with the longitudinalaxis of the trephine at the first curvature and attaching the cartilageplug to a defect site in the patient with the longitudinal axis of thetrephine at the second curvature.

Still further, a method of repairing cartilage is disclosed thatincludes choosing between a first trephine and a second trephine thatdiffer in size. Each of the first and second trephines have a respectivelongitudinal axis with a variable curvature. The method also includesforming an incision in a patient and inserting the chosen trephinethrough the incision into the patient. Furthermore, the method includesremoving a cartilage plug from a donor site in a joint of the patientwith a longitudinal axis of the chosen trephine being substantiallystraight and substantially normal to the donor site. Still further, themethod includes operably and removably coupling a guide tool to thechosen trephine. Moreover, the method includes guiding the chosentrephine with the guide tool to adjust a curvature of the respectivelongitudinal axis of the chosen trephine to be non-linear to direct therespective longitudinal axis to be substantially normal to a defect sitein the joint of the patient. Additionally, the method includes insertinga flexible ejector tool into the chosen trephine and advancing theejector tool along the longitudinal axis to eject the cartilage plugtoward the defect site and attaching the cartilage plug to the defectsite.

Further areas of applicability will become apparent from the descriptionprovided herein. It should be understood that the description andspecific examples are intended for purposes of illustration only and arenot intended to limit the scope of the present disclosure.

DRAWINGS

The drawings described herein are for illustration purposes only and arenot intended to limit the scope of the present disclosure in any way.

FIG. 1 is a schematic view of a system for repairing cartilage accordingto various exemplary embodiments of the present disclosure;

FIG. 2 is a front view of a flexible trephine of the system of FIG. 1according to various exemplary embodiments of the present disclosure;

FIG. 3 is a section view of the trephine taken along the line 3-3 ofFIG. 2;

FIG. 4 is a perspective view of the flexible trephine of FIG. 2;

FIG. 5A is a perspective view of a knee joint that is being repairedusing the system of FIG. 1, wherein cartilage is being harvested from adonor site in the knee joint;

FIG. 5B is a perspective view of the knee joint of FIG. 5A, whereinharvested cartilage is being moved to a defect site in the knee jointusing the system of FIG. 1; and

FIG. 6 is a schematic view of a hip joint that is being repaired usingthe system of FIG. 1.

DETAILED DESCRIPTION

The following description is merely exemplary in nature and is notintended to limit the present disclosure, application, or uses. Itshould be understood that throughout the drawings, correspondingreference numerals indicate like or corresponding parts and features.

Referring initially to FIG. 1, a system 10 for repairing, harvesting,and placement of cartilage (e.g., a cartilage plug including bothcartilage and attached bone tissue) is shown. The system 10 cangenerally include one or more trephines 12. Generally, the trephines 12can each be elongate, hollow, and tubular. The trephines 12 can eachinclude a proximal end 20 and a distal end 22. A cutting member 36 canbe included on the distal end 22. Also, the trephines 12 can each beflexible such that a curvature of the longitudinal axis X of thetrephine 12 can be selectively adjusted. More specifically, as will bediscussed, the longitudinal axis X can be substantially linear (i.e.,straight, can have substantially zero curvature, etc), and the trephine12 can be selectively adjusted such that the axis X is non-linear (i.e.,curved, can have positive curvature, etc.) The cutting member 36 can berotationally driven to cut and harvest cartilage from an area of apatient, and the harvested cartilage can be received and retained withinthe distal end 22. The flexibility of the trephine 12 allows thetrephine 12 to be routed more easily and conveniently toward desiredlocations in the patient's body as will be further discussed.

Furthermore, the system 10 can include one or more ejector tools 14. Theejector tools 14 can each be elongate and flexible. The ejector tools 14can be received in respective trephines 12 and can be advanced along theaxis X thereof to eject harvested cartilage from the trephines 12, aswill be discussed in greater detail below.

Moreover, the system 10 can include one or more first guide tools 16.The first guide tools 16 can each include a respective coupling portion46 and a handle 48 that extends therefrom. As will be discussed, thecoupling portion 46 can be sized and shaped to removably engage andcouple to a respective trephine 12, and the handle 48 can be used toguide and steer the respective trephine 12 by selectively moving andflexing (i.e., bending) the respective trephine 12. Accordingly, thefirst guide tools 16 can route and guide the respective trephine 12and/or guide the distal end 22 of the respective trephine 12 toward adesired location in the patient as will be discussed in greater detail.

In addition, the system 10 can include one or more second guide orcannulated tools 18. Each second guide tool 18 can include an elongate,rigid, hollow (i.e., cannulated) tube with a proximal end 52 and adistal end 54. The second guide tools 18 can each have a respectivelongitudinal axis X′. In some embodiments, the axis X′ can be straightand in other embodiments, the axis X′ can be curved. In otherembodiments, the second guide tools 18 can be non-resiliently bendableor malleable such that the curvature of the respective axis X′ can bevaried. Moreover, each second guide tool 18 can receive a respectivetrephine 12. Thus, if the second guide tool 18 has a positive curvature,then the respective trephine 12 can flex and bend along the curvature ofthe second guide tool 18 as the respective trephine advances along thesecond guide tool 18. Accordingly, the second guide tools 18 can routeand guide the respective trephine 12 toward a desired location in thepatient as will be discussed.

As shown in FIG. 1, the trephines 12 within the system 10 can differfrom each other. For instance, the trephines 12 can differ in size(e.g., width, length, or any other suitable dimension). The trephines 12can also differ in flexibility, in material, or in any other manner,such that the system 10 includes a wide variety of trephines 12.Likewise, the ejector tools 14 can differ in width, length, flexibility,material, or in any other suitable manner. Additionally, the first guidetools 16 can differ in size, material, etc. For instance, some of thefirst guide tools 16 can have similarly sized coupling portions 46 withdifferently sized handles 48 and vice versa. Furthermore, the secondguide tools 18 can each vary in length, size, curvature, or in any othersuitable manner. It will be appreciated that the system 10 can includeany number and any variety of trephines 12, ejector tools 14, and firstand second guide tools 16, 18.

Thus, the user can select between any of the trephines 12, the ejectortools 14, the first guide tools 16, and/or the second guide tools 18 foruse. The selection can be based on the anatomical dimensions of aparticular patient (e.g., the position, size, clearance, etc. of thecartilage donor and/or defect locations) or based on any other suitablebasis. Thus, the system 10 can be very versatile.

Moreover, each trephine 12 can include a dedicated one of the ejectortools 14, the first guide tools 16 and/or the second guide tools 18.Thus, for example, when the user selects a trephine 12 for use, therecan be an ejector tool 14, a first guide tool 16, and/or a second guidetool 18 that is clearly useable with the chosen trephine 12.

Referring now to FIGS. 2-4, a representative trephine 12 will bedescribed in greater detail. As shown, the trephine 12 can be generallyelongate with a proximal end 20 and a distal end 22, and with alongitudinal axis X (FIG. 2). The trephine 12 can also be hollow so asto define a passage 24 that extends along the entire longitudinal axisX. Furthermore, as shown in FIG. 3, the proximal end 20 of the trephine12 can include an opening 26 (e.g., a through hole), which providesaccess to the passage 24 on the proximal end 20 of the trephine 12.Also, as shown in FIG. 2, the proximal end 20 can include a driver 28,which is operable to drive the trephine 12 in rotation about thelongitudinal axis X. For instance, the driver 28 can be polygonal and/orcan include one or more flat surfaces 29 (FIG. 3). The driver 28 can berotationally driven by a powered tool or by manual power.

The trephine 12 can be made out of any suitable material. For instance,in some embodiments, the trephine 12 is made out of a rigid material,such as stainless steel.

Additionally, the cutting member 36 can include a plurality of sharpenededges 38 that are spaced equally about the longitudinal axis X and thatare separated by a plurality of notches 40. As will be described, thecutting member 36 can be operable to cut and core a cartilage plug(i.e., cartilage and supporting bone tissue) away from a selected sitein the patient when the trephine 12 drivingly rotates about the axis X.The cartilage plug can be received and retained within the passage 24inside the trephine 12 such that the cartilage plug can be moved to adesired site within the patient.

Moreover, as stated above, the trephine 12 can be flexible. Accordingly,the trephine 12 can selectively bend and change the curvature of thelongitudinal axis X. For instance, as shown in FIG. 2, the trephine 12can selectively move between a first, axially straight or linearposition (shown in solid lines in FIG. 2) and a second, axially curvedor non-linear position (shown partially in phantom lines in FIG. 2). Aswill be described in greater detail below, the flexibility of thetrephine 12 allows the trephine 12 to be routed, guided, or directedtoward any suitable location. Accordingly, the flexibility of thetrephine 12 allows for increased versatility. Also, the trephine 12 canbe advantageously used in a minimally invasive manner (e.g.,arthroscopically).

The trephine 12 can be flexible due to any suitable feature. Forinstance, as shown in FIGS. 2 and 4, the trephine 12 can include atleast one slot 30. The slot 30 can be formed in any suitable fashion,such as laser cutting or wire EDM cutting. The slot 30 can continuouslyextend generally helically about the longitudinal axis X. Also, the slot30 can define a plurality of projections 32 and a plurality of recesses34. The projections 32 and recesses 34 can extend generally transverseto the longitudinal axis X. Also, the recesses 34 can receive respectiveprojections 32, as shown in FIG. 4. Accordingly, the trephine 12 canflex about the slot 30 to allow the trephine 12 to bend along thelongitudinal axis X. In some embodiments, the trephine 12 can flexbetween 0 and 90°. Also, the trephine 12 and the slot 30 can incorporateany suitable feature from U.S. Pat. No. 6,447,518, issued Sep. 10, 2002to Krause et al., which is hereby incorporated by reference in itsentirety.

Furthermore, torque can be transferred between the proximal and distalends 20, 22 of the trephine because the projections 32 are receivedwithin respective recesses 34. Thus, as torque applied to the driver 28can be transferred to the cutting member 36 on the distal end 22,regardless of whether the trephine 12 is axially straight or curved.

Referring back to FIG. 1, the ejector tools 14 will be described ingreater detail. As shown, the ejector tools 14 can each be elongate andcan include a proximal end 42 and a distal end 44. The distal end 44 canbe tapered and pointed. Also, the ejector tools 14 can be flexible.Also, as will be discussed, the distal end 44 can be received within theopening 26 of the trephine 12 (see FIG. 5B) and the ejector tool 14 canextend longitudinally along the trephine 12. As will be discussed, theejector tool 14 can extend from the proximal end 20 of the trephine 12to the distal end 22 in order to push cartilage from the distal end 22of the trephine 12.

Still referring to FIG. 1, the first guide tools 16 will be discussed ingreater detail. As shown in FIG. 1, the first guide tools 16 can eachinclude a coupling portion 46 and an elongate handle 48 that extendsfrom the coupling portion 46. The coupling portion 46 can besubstantially C-shaped so as to define an opening 50. Also, the couplingportion 46 can be resiliently flexible.

The coupling portion 46 can be operably and removably coupled to arespective trephine 12 in any suitable fashion. For instance, thetrephine 12 can move through the opening 50 such that the couplingportion 46 resiliently expands, and as the trephine 12 is receivedwithin the coupling portion 46, the coupling portion 46 can resilientlysnap fit and retain the trephine 12 therein due to friction (see FIG.6). Also, when the coupling portion 46 is attached, a load applied tothe handle 48 can transfer to the coupling portion 46 to thereby push orpull the trephine 12 and flexibly bend or guide the distal end 22 of thetrephine 12 toward a desired location. Also, the coupling portion 46 canbe removed from the trephine 12 by pulling the trephine 12 out of thecoupling portion 46 through the opening 50. In some embodiments, thecoupling portion 46 is only used to guide and bend the trephine 12 andis removed before the trephine 12 is driven in rotation; however, inother embodiments, the coupling portion 46 and the trephine 12 areslidingly engaged such that the trephine 12 can rotate within thecoupling portion 46 to remove the cartilage plug, etc.

Additionally, as discussed above and as shown in FIG. 1, the secondguide tools 18 can each be elongate so as to define a proximal end 52and a distal end 54 as well as a respective axis X′. The second guidetools 18 can each be substantially rigid and hollow so as to define apassage 56 that extends between the proximal and distal ends 52, 54. Thetrephines 12 can be removably (e.g., slidably) received within thepassage 56 of the second guide tools 18 and can be advanced from theproximal end 52 to the distal end 54 (see FIG. 5B).

It will be appreciated that the system 10 can include both the firstguide tool 16 and the second guide tools 18. However, in otherembodiments, the system 10 can include only either the first guide tools16 or the second guide tools 18 without departing from the scope of thepresent disclosure. Also, it will be appreciated that the system 10 caninclude any suitable instrument (other than the first and second guidetools 16, 18) for guiding the trephines 12.

The method of using the system 10 will now be discussed in greaterdetail. Initially, the user can analyze the patient's anatomy, thelocation of the cartilage to be harvested, the location of the damagedcartilage, or any other necessary features. This analysis can be carriedout using ultrasonic diagnostic tools, imaging tools (e.g., X-rays, MRI,etc.) or using any other suitable means. Using this information, thesurgeon can select the corresponding trephine 12, ejector tool 14,and/or guide tool 16, 18 necessary to perform the procedure. Forinstance, the surgeon can select the proper size, shape, material, etc.necessary to perform the procedure for the specific patient.

Then, as shown in FIG. 5A, the system 10 can be used for removing orharvesting a cartilage plug 60 from a donor site 62 within a knee joint64 of the patient. For instance, the donor site 62 can be located on adistal, anterior portion of a femur 66. Next, as shown in FIG. 5B, thesystem 10 can be used for attaching the cartilage plug 60 to a defectsite 68 (i.e., the location of damaged cartilage) within the knee joint64. For instance, the defect site 68 can be located on a posterior,condylar surface of the femur 66. As will be discussed, because of theflexibility of trephine 12, the same trephine 12 can be routed to boththe donor site 62 as well as the defect site 68, despite differences insurface curvature and access to the donor and defect sites 62, 68.

Also, in some embodiments, the trephine 12 can be used to prepare thedefect site 68. For instance, before the cartilage plug 60 is harvestedfrom the donor site 62, the trephine 12 can be guided to the defect site68 to remove a defective cartilage plug (i.e., defective cartilage andsupporting bone tissue) and to form a hole, opening or recess at thedefect site 68. Then, the trephine 12 can be removed from the patient,and the defective cartilage plug can be removed from the trephine 12.Next, the trephine 12 can be guided to the donor site 62 to harvest thecartilage plug 60, and then the trephine 12 can be guided to the defectsite 68 for placement of the cartilage plug 60 in the prepared defectsite 68. In still other embodiments, a tool other than the trephine 12is used for preparing the defect site 68.

The procedure will now be discussed in greater detail. As shown in FIG.5A, an incision 70 can be formed in the skin 72 of the patient (bothshown in phantom). It will be appreciated that the method can beperformed arthroscopically; thus, the incision 70 can be relativelysmall (e.g., slightly larger than the width of the trephine 12). In someembodiments, the knee joint 64 can be bent as shown in FIG. 5A, and theincision 70 can be made substantially directly over the donor site 62.

Assuming that the defect site 68 has already been prepared, the trephine12 can be inserted into the patient through the incision 70 forharvesting the cartilage plug 60 from the donor site 62. In someembodiments, the trephine 12 can be inserted when the trephine 12 isaxially straight, and the axis X of the trephine 12 can be directedsubstantially normal to the donor site 62. However, in otherembodiments, the trephine 12 can be non-linear when advanced toward thedonor site 62. Also, the distal end 22 of the trephine 12 can beadvanced toward the donor site 62 using either the first or second guidetools 16, 18, or trephine 12 can be advanced independently, without theaid of the guide tools 16, 18.

Furthermore, the trephine 12 can be operably coupled at the proximal end20 to a motorized device 91. More specifically, the motorized device 91can include a chuck or other suitable coupling for operably coupling tothe driver 28 of the trephine 12 such that the motorized device 91 candrivingly rotate the trephine 12 about the longitudinal axis X.

As the trephine 12 rotates over the donor site 62 and the trephine 12 ismaintained in an axially straight position, the cutting member 36 cancut and core the cartilage plug 60 from the donor site 62, and thecartilage plug 60 can be received and retained within the distal end 22of the trephine 12.

Next, as shown in FIG. 5B, the curvature of the trephine 12 can beadjusted such that the trephine 12 curves from the incision 70 towardthe defect site 68. More specifically, the trephine 12 can be removedfrom the patient, and an appropriate second guide tool 18 can beinserted through the incision 70 and directed toward the defect site 68.Then, the trephine 12 can be inserted into the proximal end 52 of thesecond guide tool 18 and advanced along the passage 56 of the secondguide tool 18 in order to guidingly bend the trephine 12 toward thedefect site 68. In some embodiments, the second guide tool 18 can curvethe trephine 12 toward the defect site 68 such that the axis X of thetrephine 12 is directed substantially normal to the defect site 68.

Subsequently, as shown in FIG. 5B, the ejector tool 14 can be insertedinto the opening 26 and advanced along the trephine 12 toward thecartilage plug 60 retained within the distal end 22 of the trephine 12.The ejector tool 14 can then be used to push the cartilage plug 60 outonto the prepared defect site 68. The mass of cartilage plug 60 can bepressed against the defect site 68 and retained on the defect site 68through any suitable means, such as a press fit, frictional fit, or anyother suitable means. Eventually, the mass of cartilage plug 60 canattach and grow on the defect site 68 to restore proper function of theknee joint.

Referring now to FIG. 6, another method of using the system 10 will bedescribed. As shown, the system 10 can be used for harvesting andreplacing cartilage in an acetabular cup 80 of a hip joint 82. Themethod of use is substantially similar to the method of use describedabove with respect to FIGS. 5A and 5B. However, as shown in FIG. 6, thefirst guide tool 16 can be used to adjust the curvature of the trephine12 instead of the second guide tool 18.

More specifically, after the trephine 12 has harvested and collected thecartilage plug from the donor site 84, the coupling portion 46 of theguide tools 16 can be operably coupled to the distal end 22 of thetrephine 12 as discussed above. Then, a load F can be applied to thehandle 48 (which is extending out of the patient) in order to curve androute the trephine 12 toward the defect site 86.

It will be appreciated that the longitudinal axis X of the trephine 12can be directed substantially normal to both the donor site 84 and thedefect site 86 by adjusting the curvature of the trephine 12, asdescribed above. Furthermore, it will be appreciated that theflexibility of the trephine 12 allows the trephine 12 to be maneuveredwithin the acetabular cup 80 in a convenient manner. For instance, thetrephine 12 can be curved around the rim 88 of the acetabular cup 80such that the trephine 12 is unlikely to abut against the rim 88.Accordingly, the trephine 12 can be very versatile and convenient foruse.

In summary, the system 10 and methods described above can allow forseveral advantages. For instance, only one incision may be necessary forcompleting the operation because the trephine 12 is flexible and can berouted more easily within the patient. Also, the trephine 12 can berouted around anatomical structures very conveniently. Thus, theprocedure can cause the patient less trauma, and the system 10 canprovide substantial versatility for use in a wide variety of patientsand procedures.

While the donor site 62 and the defect site 68 are located in the samejoint in the method described above, it will be appreciated that thedonor site 62 and defect site 68 can be located in separate areas of thebody. Moreover, while the method described above includes bothharvesting cartilage and placing the harvested cartilage on a defectsite 68, it will be appreciated that the system 10 can be used only toharvest cartilage or only to place cartilage on a defect site 68 withoutdeparting from the scope of the present disclosure. In addition, thesystem 10 can be used to place any suitable material on the defect site68 (including anatomical cartilage from the same patient, anatomicalcartilage from another patient, anatomical cartilage from anotherspecies, or artificial cartilage) without departing from the scope ofthe present disclosure.

Moreover, the foregoing discussion discloses and describes merelyexemplary embodiments of the present disclosure. One skilled in the artwill readily recognize from such discussion, and from the accompanyingdrawings and claims, that various changes, modifications and variationsmay be made therein without departing from the spirit and scope of thedisclosure as defined in the following claims. For instance, thesequence of the blocks of the method described herein can be changedwithout departing from the scope of the present disclosure.

What is claimed is:
 1. A system for repairing cartilage comprising: atrephine having a passage extending along a longitudinal axis of thetrephine, a distal end, and a proximal end, the distal end including acutting member operable to cut a cartilage plug from a donor site, thepassage operable to receive the cartilage plug, the trephine beingflexible to selectively move between a first position in which thelongitudinal axis is substantially linear and a second position in whichthe longitudinal axis is nonlinear; a guide tool that is removablycoupled to the trephine, the guide tool operable to selectively move thetrephine between the first and second positions; and an ejector toolthat ejects the cartilage plug from the passage toward a defect site. 2.The system of claim 1, wherein the trephine is made of a rigid material,and wherein the trephine includes at least one slot, the trephineflexing about the slot as the trephine moves from the first position tothe second position.
 3. The system of claim 1, wherein the ejector toolincludes an elongate, flexible rod that is removably received in thepassage.
 4. The system of claim 1, wherein the guide tool includes acoupling portion that operably couples to the trephine and an elongatehandle that extends from the coupling portion.
 5. The system of claim 4,wherein the coupling portion is resilient so as to resiliently receivethe trephine and to removably couple to the trephine.
 6. The system ofclaim 4, wherein the coupling portion is substantially C-shaped with anopening, the trephine movable through the opening to flex the couplingportion.
 7. The system of claim 1, wherein the guide tool includes arigid cannulated tube with a non-linear longitudinal axis, the trephinebeing removably received within the tube to guide the trephine along thenon-linear longitudinal axis as the trephine advances in the tube.
 8. Asystem for repairing cartilage, comprising: a trephine extending along alongitudinal axis between a distal end and a proximal end, the distalend including a cutting member operable to cut a tissue plug from adonor site and the trephine including a passage operable to receive thetissue plug, the trephine being flexible to selectively move between afirst position in which the longitudinal axis is substantially linearand a second position in which the longitudinal axis is nonlinear; aguide tool configured to be removably coupled to the trephine, the guidetool operable to selectively move the trephine between the firstposition and the second position; and an ejector tool configured tocooperate with the trephine to eject the tissue plug from the passage;wherein the trephine is configured to be moved between the firstposition and the second position with cooperation of the guide tool. 9.The system of claim 8, wherein the guide tool includes a rigidcannulated tube; wherein the rigid cannulated tube includes a non-linearlongitudinal axis, the trephine being removably received within therigid cannulated tube to move the trephine from the first position tothe second position.
 10. The system of claim 9, wherein a first end ofthe guide tube is configured to be placed near a tissue receiving siteand the trephine is configured to be moved through the cannulated tubefrom a second end along a non-linear longitudinal axis within the rigidcannulated tube.
 11. The system of claim 9, wherein the cannulated tubeis selectively bendable to selectively vary the longitudinal axis of thecannulated tube.
 12. The system of claim 8, wherein the guide toolincludes a coupling portion to removeably couple near at least thedistal end of the trephine to move the trephine between the firstposition and the second position.
 13. The system of claim 12, whereinthe coupling portion is substantially C-shaped with an opening, thetrephine movable through the opening to flex the coupling portion. 14.The system of claim 12, wherein the coupling portion engagessubstantially only near the distal end of the trephine.
 15. The systemof claim 8, wherein the trephine is formed of a rigid material andincludes at least one slot, the trephine is configured to flex relativeto the slot as the trephine moves from the first position to the secondposition.
 16. The system of claim 15, wherein the slot includes at leasta portion that is continuously extending helically about thelongitudinal axis of the trephine.
 17. The system of claim 8, whereinthe ejector tool includes an elongate, flexible rod that is removablyreceived in the passage.
 18. A system for repairing cartilage,comprising: a trephine having a flexible exterior wall extending from aproximal end to a distal end and having a passage therethrough, whereinthe trephine is operable to be moved from a first position to a secondposition to alter a shape of a longitudinal axis of the trephine; and aguide tool configured to operably engage at least a portion of theflexible exterior wall to move the trephine from the first position tothe second position.
 19. The system of claim 18, wherein the flexibleexterior wall is formed of a rigid material having at least one slotformed therethrough to allow a first portion of the flexible exteriorwall to move relative to the second portion of the flexible exteriorwall.
 20. The system of claim 18, wherein the guide tool includes acannulated tube and the trephine is configured to pass through thecannulated tube to move from the first position to the second position.21. The system of claim 20, wherein the cannulated tube includes apassage to receive the trephine and the trephine can flex and bend alonga curvature of the cannulated tube as the respective trephine advancesalong the cannulated tube.
 22. The system of claim 18, wherein the guidetool includes a coupling portion to engage substantially near the distalend to move the trephine from the first position to the second position.23. The system of claim 18, further comprising: an ejector portionconfigured to assist in removing a tissue portion from the passage.